headshot - AHCA/NCAL President and CEO Mark Parkinson

Nursing homes’ largest advocacy group on Wednesday launched a national campaign to boost hiring in the face of an unprecedented worker shortage that is curtailing capacity and threatening the ability to serve residents.

“It’s impossible to exaggerate the challenges that providers face in providing care because of the inability to hire workers,” said Mark Parkinson, president and CEO of the American Health Care Association/National Center for Assisted Living.

While doctors’ offices, and the home health and hospice sectors have recovered to pre-pandemic employment levels, skilled nursing facilities are short almost a quarter-million employees. In addition, assisted living facilities remain down by approximately 40,000 workers, Parkinson said during a media call Wednesday. And those are the numbers the long-term care industry needs to hire just to reach parity with pre-pandemic staffing levels. 

“It is unique to long-term care that we face this crisis,” Parkinson said, adding that 96% of providers report that they cannot hire workers. “This is not a normal type of labor situation that we have seen in the past. There’s been challenges, but it has never been like this where we’ve had a material reduction in the workforce and an inability to admit people because of the loss of workers.”

The association launched a job education website called Careers in Caring, which gives providers tools and resources to aid in hiring. They include research-tested methods to reach job candidates, informational videos about working in the industry, messaging materials, social media tools, and templates for press releases. The site also includes a template for Myth-Fact documents to help push back against disinformation. 

Among the myriad challenges the sector faces are low wages and Medicaid rates that do not reflect the real costs with which providers are dealing, AHCA leaders explained. 

Currently, Medicaid is funding only 84% of the operating costs for rural facilities, said another media call participant, Phil Fogg, the president of the AHCA/NCAL board of directors and the president and CEO of Marquis Companies. Providers need reimbursement stability, so states might need to look at a critical access designation, similar to that given to hospitals in similar areas, to provide a steadying financial hand, Fogg asserted.

Reforms needed to increase staffing capacity

Providers also face the specter of a promised first-ever federal minimum staffing mandate.

“Our current workforce is tired and burned out,” Fogg said, noting that his company has the largest number of job openings in its 33-year history. “The workforce shortage is creating serious access issues. In rural communities, you’re literally seeing facilities close because they cannot get the staff to meet not only their state and federal requirements but to care for the people in that community.”

The sector is pushing various policy reforms, such as increasing workforce visas in the immigration system, boosting capacity in education and jobs programs, and promoting long-term care careers in high school, and getting licensing agencies to be quicker and more efficient. 

The campaign to recruit new employees — or win back former workers — will focus on two broad message areas: long-term care is a calling through which people can find fulfillment; and it offers professional job advancement that can see a worker go from a nursing aide to an administrator to even an owner/operator. The association conducted focus groups and surveys with former and current workers to determine what motivates employees to stay or leave. 

“There are very few occupations where you can provide the type of satisfaction to a person who has a real desire to help other people,” Parkinson said. “They don’t come into the space for money; they really see it as a calling.”